MEDICAL JURISPRUDENCE😊

MEDICAL JURISPRUDENCE

Offences

• Based on arrest warrant.
1. Cognizable offence: Arrest without warrant.
• Murder
• Rape
• Kidnapping
• Robbery
• Dowry death
• Grievous hurt
• Terrorism-related offences
2. Non-cognizable offence: Only arrest with warrant.

Inquest

• Mnemonic:
• Magistrate → Magic
• Judist magic (Judicial magistrate) → exhume () → take money (dowry) → take in custody and rape (custodial death and rape)
• Ex magic → exhume () and just take money (dowry)

• Conducting enquiry.

• Types:
• Police inquest: 194 BNSS (m/c).
• Power to summon witness: 195 BNSS
• Magistrate inquest: 196 BNSS (Superior).
• Coroner’s inquest.
• Medical examiner system (Best).

Magistrate inquest:

• Magistrate inquest: JM > EM
1. Judicial magistrate (superior):
• Court of law.
• Custodial death/rape.
• Dowry death.
• Exhumation.
2. Executive magistrate:
• Government official (collector, tahsildar, RDO).
• Dowry death.
• Exhumation.

• Custodial death:
• Death in police station, jail, psychiatric hospital, juvenile home.

Police inquest:

• Minimum rank of IO
• Sub inspector: Sexual offenses
• head constable: Others

• Power to summon witness (195 BNSS).

• Sections 63–71 of BNSS deal with summons

• Witness: Panchas.

• Enquiry report: Panchanama.

• IO: Investigating Officer.

• Mnemonic: 19 vayassulla 4 Police (194) → answeshikkan irangi → summoned 1 more (195) → pne magistrate nu koduth (196)

INDIAN LEGAL SYSTEM HIERARCHY

Hierarchy:

• Supreme court (Nation):
• Apex courts.
• Any sentence (Death sentence also).

• High court (State).

• Sessions court, additional sessions & fast track court (District).

• Trial courts:
• Second class magistrate (Judicial): 
• 1 year punishment, 10k fine.
• First class magistrate (Principle magistrate): 
• 3 years punishment, 50k fine.
• Chief judicial magistrate: 
• 7 years punishment, No limit.
• Assistant sessions:
• 10 years punishment, No limit.

• Lowest court to give death sentence: District courts.

• Lowest court to confirm/commute/cancel death sentence: High court.

• Death sentence by supreme court can be commuted by: President/ State Governor.

• Death sentence of a pregnant women by a district court have to be changed to life imprisonment by high court → 456 BNS
• Ridwi (456) high court → pregnant woman ne rakshapeduthum

Mnemonic:

• District is busy → so hold fast (fast) aytt sessions () add (additional) cheyyum

• Magic
• 1st year magician → second class () → 10k slaary (fine) → Judist (juducial masitrate) person
• 3rd year PG magician (Primary magistrate) → 1st class → 50k salary
• After 7 years → becomes chief → No limit for them
• Judans → PGS → chief

EVIDENCE & WITNESS

Evidence:

• Statement/fact produced in court to prove/disprove something.

• Types:
• Direct evidence :
• Eyewitness
• Directly proving fact.
• More valid.
• Indirect evidence :
• Not seen the person killing victim
• Not directly proving.
1. Corroborative evidence :
• Seen weapon in the hand of a person
2. Circumstantial :
• Fingerprints of the accused at the crime scene
3. Hearsay :
• A person killed B, C has seen it, and he or she came out of the crime and said to D that A killed B.
• Hearsay evidence is not valid.
• Oral statement:
• Superior.
• Can be cross-examined.
• Documentary.

'A' kills 'B' with a knife. Another person 'Z' saw 'A' with knife in the park few minutes before murder.
'Z' give this statement in court of law. What kind of evidence is it?

Witness:

• Common/Occurrence/Facts witness:
• Eligibility: Any person who has perceived the fact.
• No age limit.
• Evidence: Only facts.
• Opinion: None.
• First hand knowledge rule: (+)

• Expert witness:
• Eligibility: By virtue of:
• Knowledge/skill.
• Experience.
• Training.
• Evidence: Facts.
• Opinion: Can give.
• First hand knowledge rule: (-)

SUMMONS

• AKA Subpoena (Under penalty for civil/criminal court).
• Mnemonic: Poem paranj vilikkum

• Legal document issued by the presiding officer of the court.

• Compelling the attendance of witness.

• If ignored: Wilful disobedience (Punishable).

Types:

• Subpoena ad testificandum:
• Give oral statement
• Mnemonic: Ads are given orally

• Subpoena duces tecum:
• Produce documentation.
• Mnemonic: Duc → Doc

Order of attendance in case of multiple summons:

• Higher court > Lower court.

• Criminal court > Civil court.

• Equal status of courts:
• 1st one to summon.

Conduct/diet money:

• Paid to witness for travelling expenses (While serving summon in civil cases).

• Paid by parties in the civil case.

• Amount fixed by court.

COURT PROCEEDINGS

Types of Cases:

• Criminal cases: b/w state and accused.

• Civil cases: Between any 2 parties.

Recording of Evidence in the Court:

• Steps:
1. Oath/Solemn affirmation:
• Compulsory, on refusal Punishable.
• Child < 12 years exempted.
2. Chief/direct examination.
3. Cross examination.
4. Re-direct examination.

• Extra powers of a judge:
• Questions can be asked at any stage of trial.
• Can re-call/re-examine witnesses.

Difference in direct vs. cross vs. redirect examination:

• Note:
• Perjury (False evidence under oath): [D] 227 BNS.
• Fabrication of evidence: [D] 228 BNS.
• Both punishable: [P] 229 BNS.
• Mnemonic: 22 year ullapo Vaishna Witness parayn poi → Kallam paranj, fabricate cheyth

Dying Declarations vs. Dying Depositions:

Compos mentis

• When a dying declaration is being recorded,

• role of the doctor is to assess his/her mental capacity

Testamentary Capacity

• Mental ability of a person to make a valid will (Testament = will)

MEDICAL ETHICS

Medical Ethics vs Etiquette:

• Medical ethics:
• Compulsory and punishable.
• Guiding moral principles for:
• Doctor-doctor.
• Doctor-patient.
• Doctor-state.

• Medical etiquette:
• Not compulsory.
• Dealing with colleagues.
• Relationships.

Infamous/ Unethical Conduct/ Professional Misconduct:

• Warning notice is given to all doctors informing about:
• Addiction.
• Alcohol.
• Practicing under influence.
• Adultery.
• False certificate issue.
• Gifts from pharmacy.
• Dichotomy
• Fee splitting.
• Euthanasia
• Active is crime
• Passive is permitted in India
• Conducting criminal abortion.
• Association with unqualified person.
• Covering: Assisting/employing unqualified person.
• Advertisements (Repeated/inappropriate).

• Disciplinary Action Taken by:
• State medical council (SMC).
• Ethics & Medical Registration Board (EMRB).

• Appeal:
• If punished, one can appeal to higher body.
• SMC → EMRB → NMC (National Medical Commission).

• Punishments:
• Warning.
• Remove name from state medical register (Penal erasure):
• Temporary.
• Permanent (Professional death sentence).

Declarations:

• Declaration Guidelines about:

Declaration	Guidelines about	Mnemonic:
Helsinki	Human experimentation	H → H
Oslo	Therapeutic abortion	Os → cervical os → Abortion
Geneva	Medical ethics (Modified Hippocratic oath)	ㅤ
Venice	Terminal illness	V → Terminal alphabet
Lisbon	Patient rights	L → Left → Right
Malta	Hunger strike	Malta → Maltose → hunger
Washington	Biological weapon	Washing away microorganisms
Tokyo	Torture	Tokyo → likes to Torture
Sydney	Death declaration	Syd → Death

NOTE: Other Ottawas

OTTAWA RULES:

• When to take Xray in ankle trauma

• M/c injury → Anterior Talofibular Ligament tear

Ottawa Convention (Mine Ban Treaty)

• 1997 treaty.

• Bans use, stockpiling, production, transfer of anti-personnel landmines.

• Requires:
• Destruction of stockpiles within 4 years.
• Clearance of mined areas within 10 years.
• Assistance to victims.

• Not signed by:
• USA
• Russia
• China
• India
• Pakistan

Tillaux #

• Distal tibia → salter haris 3

• Avulsion fracture

DANIS- WEBER classification:

• For ankle #

Dancers # → Pseudo jones

Jumpers # → Sacrum

Denis classification

Judet and letournel: Acetabulum #

Young and Burgess: Pelvic #

Schatzker classification: Tibia #

EVANS CLASSFICATION → IT #

Basic Ethical Principles:

1. Autonomy: Right of patient to choose treatment.

2. Justice: Treat all patients same without discrimination.

3. Beneficence: For the benefit of patient.

4. Non-maleficence: Do no harm.

MEDICAL NEGLIGENCE/MALPRACTICES

• Omission of right/commission of wrong.

• Factors Comprising Negligence:
1. Direct causation.
2. Dereliction of duty:
• Deficiency in duty:
• Absence of reasonable skill or care/willful negligence.
3. Damage:
• Monetary loss.
• Suffering from pain.
• Disability.
• Death.

Q. If a healthcare professional is found guilty of professional misconduct, they must provide patient's records promptly upon request, within:

• 72 hours

Types:

Doctrines:

• Res ipsa loquitur (Facts speaks for itself):
• Gross negligent act by doctor.
• No expert opinion needed.
• Burden of proof of innocence lies on doctor.
• Mnemonic: Locking the doctor → Doctor should prove → to unlock

• Respondent superior (Let the master answer):
• Superior is liable for negligent act of the third party.
• Employer is responsible for the negligence of the employee
• Vicarious liability
• Only applicable for civil cases.

• Borrowed servant doctrine
• When an individual commences employment with a second employer, the new employer assumes responsibility for the individual's actions.
• applies when an employee is temporarily loaned or "borrowed" by another employer

Defences:

• No duty.

• Duty given as per standard protocol:
• No dereliction of duty.

• Therapeutic misadventure/mischance:
• Accidental damage.
• Mnemonic: Misadventure = mistake = accidental mistake

• Contributory negligence (By patient).
• Mnemonic: Negligence with contribution → from who? Patient

• Novus actus interveniens:
• New unrelated intervening act leading to damage.
• Mnemonic: Novus (new) actus (act) interveniens (intervening)
• Example:
• If a person is injured in a fight and then, while recovering in the hospital, is deliberately assaulted by a third party, the assault could be considered a novus actus interveniens, breaking the causal link between the initial fight and the subsequent assault.

• Res indicata (Time limitation period):
• Civil cases (Within 2 years of knowing),
• criminal (No time limit).

• Res judicata (Things already decided):
• Patient cannot file case again if unsatisfied (Only appeal).
• Mnemonic: Judicial/judged → already judged → cannot refile

NOTE

• Medical maloccurrence
• Unfortunate event or outcome during medical treatment
• despite due care and skill.

CONSENT

Doctrines

• Doctrine of inform refusal
• right of patient to refuse treatment

1. Doctrine of full disclosure

• Give patient full information before consent.

• Consent without enough information is no consent.

2. Doctrine of partial disclosure/therapeutic privilege

• Partial disclosure to patient
• benefits patient.

• Give full disclosure to guardian.

3. Doctrine of informed refusal

• Patient can refuse treatment after knowing risks.

• Document refusal with patient’s signature.

4. Doctrine of extended consent

• Extending consent of one procedure to a life-saving procedure.

• Valid only in emergencies.

• Not in India

5. Doctrine of therapeutic waiver

• Patient waives right to consent.

6. Doctrine of emergency / Doctrine of anticipation

• Consent is not mandatory in emergency life-saving situations.

• Section 30 BNS applies.

• Valid when unable to get consent from patient/guardian.

7. Doctrine of loco parentis

• Child under 12 years:
• consent obtained by person in charge (teacher/warden).

• In absence of parent/guardian.

Rules for Consent

1. Medical Examination

• < 12 yrs: Consent by guardian (27 BNS)

2. Medicolegal Examination in Rape

• Mnemonic: 18 year old vicitm, 52 year old Accused

Miscellaneous Points

3. Undertrial Prisoner

• Mandatory consent for examination.

4. Convict

• Consent of authority for examination.